exam 5 - Infections in Immunocompromised

Question 1

what are risk factors for infection in immunocompromised

Answer 1

neutropenia
immune system defects
destruction of body
changes in flora

Question 2

how to calculate ANC

Answer 2

WBC x (%polys + %bands)

Question 3

what are the common bacterial pathogens in immunocompromised

Answer 3

s. aureus
s. epidermis
streptococci
enterococcus
enterobacterales
p. aeruginosa

Question 4

what are the common fungi in immunocompromised

Answer 4

candida, aspergillus, zygomycetes

Question 5

what are the common viruses in immunocompromised

Answer 5

herpes, VZV, CMV

Question 6

describe defect in cell mediated immunity

Answer 6

-T cells
-loss of defense against intracellular pathogens

Question 7

describe defects of humoral immunity

Answer 7

-B-cell
-loss of defense against extracellular pathogens

Question 8

what are the 3 barriers destroyed in immunocompromised

Answer 8

skin
mucous
surgery/organs

Question 9

who is at greatest risk of death from febrile neutropenia

Answer 9

ANC < 500

Question 10

how does febrile neutropenia present

Answer 10

with a fever
single oral temp >38.3 or oral temp >38 for 1hr plus

Question 11

what is the goal for febrile neutropenia

Answer 11

prevent death and infections
targeted therapy

Question 12

what is a low risk neutropenic patient

Answer 12

neutropenia <7 days and clinically stable

Question 13

what is high risk neutropenia

Answer 13

ANC <100 and neutropenic >7 days and clinically unstable

Question 14

what is the overview of empiric therapy with neutropenia

Answer 14

target most likely pathogens and always cover pseudomonas

Question 15

what is the preferred b-lactam monotherapy for febrile neutropenia

Answer 15

cefepime 2gm q8h
pip/tazo 4.5gm q6h

Question 16

what is the reserved b-lactam monotherapy for febrile neutropenia

Answer 16

imipenem 500mg q6h
meropenem 1gm q8h

Question 17

what should not be used in febrile neutropenia (b-lactam)

Answer 17

ceftazidime

Question 18

use of vanc in febrile neutropenia

Answer 18

not part of initial therapy
must be unstable, GP cultures, SSTI, severe mucositis, or MRSA

Question 19

what should be used to treat febrile neutropenia for those patients w/ blactam allergies

Answer 19

Cipro + aztreonam + vanc
cipro + augmentin
levo
cipro + clinda

Question 20

febrile neutropenia MRSA

Answer 20

vanc

Question 21

febrile neutropenia VRE

Answer 21

dapto or linezolid

Question 22

febrile neutropenia ESBL

Answer 22

carbapenem

Question 23

febrile neutropenia KPC

Answer 23

mero/vabor
imi/cil/rel
ceftaz/avi

Question 24

febrile neutropenia NDM/IMP/VIM

Answer 24

cefiderocol

Question 25

antifungal therapy for febrile neutropenia

Answer 25

amphotericin B azoles echinocandins

Question 26

how long should antifungal therapy be continued for febrile neutropenia

Answer 26

2 weeks in absence of s/sx (could be for entire course of neutropenia)

Question 27

antiviral therapy for febrile neutropenia

Answer 27

HSV/VZV - acyclovir or valacyclovir CMV - ganciclovir or valganciclovir

Question 28

what is the prophylaxis option for febrile neutropenia bacteria

Answer 28

FQs: cipro or levo

Question 29

fungal prophylaxis immunocompromised patients

Answer 29

azoles

Question 30

pjp prophylaxis for immunocompromised

Answer 30

TMP/SMX

Question 31

HSV prophylaxis in immunocompromised

Answer 31

acyclovir

Question 32

who would benefit from prophylaxis

Answer 32

high risk patients w/ ANC < 100 x 7 days heme cancers HSCT GVHD w/ steroids